| NPI | 1316123714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES VINCENT PHILLIPS Owner 661-665-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C37044) |
| Additional Taxonomies | 2086S0129X (Licence: CA C37044) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2015-02-26 |